Medical Benefit Review Services Associate

Conduent; South Dakota Park (SD); Remote; USD 34,000 - 43,000; Full time

Benefits offered by this job

Health insurance coverage

Dental and vision programs

Life and disability insurance

Retirement savings plan

Paid holidays

Paid time off (PTO)

Job summary

Conduent is seeking a Medical Benefits Review Associate to support Medicare, Medicaid and commercial claims with meticulous analysis. This remote role emphasizes accuracy in determining eligibility and resolving complex insurance issues for a fast-paced environment.

You will review paid and adjusted claims, verify member eligibility, and document findings across client systems. The position offers a fully remote schedule, a Monday–Friday workweek, and benefits starting on day one.

Qualifications

• Must be 18+ to apply.
• High school diploma or GED required.
• Pass preemployment background check and drug screening.
• Background in benefit/coverage concepts desired.
• Basic knowledge of insurance procedures and Medicare/Medicaid.
• Experience with data entry of medical claims data.
• Proficient in Microsoft Office.
• Excellent verbal and written communication.
• Understanding of medical terminology and eligibility processes.
• Strong investigative, research, and critical thinking skills.
• Strong organizational and multitasking abilities.
• Able to work independently while remote.

Responsibilities

• Review paid, adjusted, and offset claims in the client system.
• Review member eligibility and update records.
• Investigate and communicate questionable situations.
• Document findings from the client system in related systems.
• Communicate effectively with staff and team members.
• Work independently based on established procedures.

Skills

Data entry

Medical claims entry

Insurance procedures

Attention to detail

Communication skills

Microsoft Office

Independent work

Remote collaboration

Education

High school diploma or GED

Job description

Medical Benefits Review Associate

Pay: Starting at $18.00/hour (based on experience), which may be below your state's minimum wage. Please take this into consideration when applying.

Schedule: Monday-Friday | 8:00 AM -4:30 PM EST

Location: Fully Remote

About this role:

Are you experienced in various types of medical benefits and services? We're looking for a detail-oriented healthcare professional who enjoys solving complex insurance billing and coverage issues and working in a fast-paced remote environment.

Medical Benefit Review Services Associate II is responsible for providing analytical support to CPIS overpayment programs via access to the client claims systems related to Medicare, Medicaid and Commercial claim overpayments identified through various audits.

If you have strong analytical skills, enjoy researching insurance eligibility and medical claims and take pride in delivering accurate, high-quality work, we'd love to hear from you.

Key Responsibilities

• Responsibilities include (but are not limited to):
• Review of paid claims, adjusted claims, and offset claims in the client system.
• Review of member eligibility, update of member eligibility.
• Investigates and communicates questionable situations.
• Documents findings from the client system in the related systems.
• Communicate effectively with other staff/team members.
• Works independently based on established procedures.

Required Qualifications

• Must be 18 or older to apply
• Must have a high school diploma or GED
• Must be able to successfully pass a preemployment criminal background check and drug screening
• Background in benefit/coverage concepts desired
• Basic knowledge of insurance procedures, working with insurance carriers, Medicare, and Medicaid
• Experience with data entry / medical claims data entry processing
• Professional verbal and written communication skills required
• Proficiency with Microsoft Office (Word, Excel, and Outlook)
• Understanding of medical terminology and healthcare eligibility processes
• Strong investigative, research, and critical thinking skills
• Excellent verbal and written communication skills
• Strong organizational and multitasking abilities
• Ability to work independently while collaborating effectively with a remote team

Why You'll Love This Opportunity

• Fully remote position
• Flexible Monday-Friday schedule
• No weekends required
• Competitive starting pay
• Collaborative team environment
• Eligible for benefits day 1

Due to varying state and local minimum wage laws, we are currently only able to hire candidates residing in states where our compensation structure complies with applicable wage regulations. As a result, we may be unable to consider applicants from certain states or municipalities at this time.

Requirements

• Must pass an internet speed test (download equal to or greater than 25, upload equal to or greater than 5, Ping ms equal to or less than 175)
• Must have the ability to connect with an ethernet cable to a modem/router
• Live in one of the following states, AL, AR, AZ, CO CT, DE, FL, GA, ID, IN, IA, KS, KY, LA, ME, MI, MS, MO, NE, NV, NH, NJ, NM, NC, OH, OK, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY

We are currently NOT hiring in the following geographies, included but not limited to

States: AK, CA, CT, HI, MA, IL, MT & NY

Metro Areas: MN – Minneapolis, IL – Chicago, NY – New York City, OR - Portland, MD - Montgomery County, WA - Seattle, Washington, DC

Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $34,320-$42,900.

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.